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Atrial pacing and thallium 201 scintigraphy: combined use for diagnosis of coronary artery disease
H G Stratmann1, A L Mark, K E Walter
1Department of Cardiology, St. Louis Veterans Administration Medical Center, Missouri.
Insights
Atrial pacing and thallium 201 scintigraphy effectively detect coronary artery disease (CAD) in patients unable to exercise. Combining these tests offers high sensitivity for diagnosing CAD.
Area of Science:
- Cardiology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Stable angina pectoris often necessitates non-exercise stress tests for diagnosing coronary artery disease (CAD).
- Patients unable to perform adequate exercise stress tests require alternative diagnostic modalities for CAD evaluation.
Purpose of the Study:
- To assess the efficacy of atrial pacing and thallium 201 scintigraphy in detecting CAD.
- To determine the combined diagnostic value of these methods in a specific patient cohort.
Main Methods:
- 36 patients with stable angina pectoris underwent atrial pacing and thallium 201 scintigraphy.
- Cardiac catheterization was performed for all patients to confirm CAD presence and severity.
- Sensitivity and specificity of each modality and their combination were analyzed.
Main Results:
- Significant CAD was present in 33 patients (92%).
- Atrial pacing induced ST depression in 55% and angina in 61% of CAD patients.
- Thallium 201 scintigraphy showed perfusion defects in 82% of CAD patients.
- The combined sensitivity of both tests for detecting CAD was 91%.
Conclusions:
- Combined atrial pacing and thallium 201 scintigraphy is a valuable diagnostic tool for CAD.
- This combined approach is particularly useful in patients unable to undergo exercise stress testing.
- The study highlights the utility of non-invasive testing for comprehensive CAD assessment.
Abstract:
To evaluate the presence of coronary artery disease (CAD), atrial pacing and thallium 201 scintigraphy were performed in 36 patients with stable angina pectoris who were unable to perform an adequate exercise stress test. All patients underwent cardiac catheterization. Nine patients had previously undergone coronary artery bypass surgery. Significant CAD (one or more lesions greater than or equal to 50%) was present in 33 patients. Atrial pacing produced ischemic ST segment depression (greater than or equal to 1 mm) in 18 (55%) patients with CAD, and angina in 20 patients (61%). As the number of vessels with CAD increased, there was no significant change in the sensitivities of pacing-induced angina or ST segment depression for detecting CAD. In the 3 patients without CAD, ST segment depression occurred in 1 patient and angina in none. Thallium 201 scintigraphy demonstrated perfusion defects in 27 (82%) patients with CAD, with fixed defects seen in 13 studies (39%) and reversible defects in 15 (45%). In the 3 patients without CAD, no perfusion defects were seen. The thallium 201 scan successfully predicted the presence of CAD in patients with single-vessel disease but usually underestimated the number of vessels involved in patients with multivessel disease. Combined sensitivity of pacing-induced ST segment depression and an abnormal thallium 201 scan finding for detecting CAD was 91%. The authors conclude that combined atrial pacing and thallium 201 scintigraphy is a useful test for detecting CAD in patients unable to perform an adequate exercise stress test.